AB0340 SHORTENING THE DOSING INTERVAL OR DOSE ESCALATION OF BIOLOGICAL DMARDs SUPPRESSED RESIDUAL ULTRASOUND SYNOVITIS AND JOINT DESTRUCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS -STARBOARD STUDY-
Authors: Y. Yamada, T. Okano, K. Mamoto, K. Inui, K. Mandai, T. Koike, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2022)

Background In patients with rheumatoid arthritis (RA) who have residual synovitis even after using biological disease modified anti-rheumatic drug (bDMARDs), joint destruction may progress 1, . The enhanced treatment such as shortening the dosing interval or dose escalation of bDMARDs are recommended for these patients, if allowed in package inserts 2, 3 . Objectives We investigated the effects of enhanced treatment in RA patients with residual synovitis under treatment with standard dose of bDMARDs. Methods Forty RA patients treated with standard dose of infliximab, tocilizumab or golimumab were included in this study. Ultrasound (US) examination was performed at the bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three parts of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18-6 MHz). Residual synovitis was defined as Power Doppler score (PD) ≥2. In patients with residual synovitis, we recommended enhanced treatment. The patients were divided into 3 groups, PD≥2/ET+ group (patients agreed enhanced treatment), PD≥2/ET- group (patients rejected enhanced treatment), and PD&lt;2 group. We assessed ultrasound (PD score), laboratory data (CRP, MMP-3), disease activity (Simplified Disease Activity Index; SDAI), physical function (Health Assessment Questionnaire; HAQ), and joint destruction (modified Total Sharp Score; mTSS) at baseline and 1-year follow-up. Results There were 9 patients in PD≥2/ET+ group and 31 patients in PD&lt;2 group. PD≥2/ET+ group had significantly higher SDAI (p=0.027), MMP-3 (p=0.005), and PD (p&lt;0.001) at baseline compared with PD&lt;2 group, but their MMP-3 (p=0.019) and PD (p=0.042) were significantly decreased over 1 year. PD≥2/ET+ group had joint destruction before ET (p=0.022), but it was suppressed after ET and there was no significance in change in mTSS compared with PD&lt;2 group (p&gt;0.99) (Figure 1). Figure 1. Disease activity, ultrasound assessment and radiographic change from baseline (BL) to 1-year follow-up in RA patients with residual synovitis who had enhanced treatment (PD≥2/ET+) and those without active synovitis (PD&lt;2). *Each parameter at BL and 1-year was statistically analyzed by Wilcoxin signed rank test only in PD≥2/ET+ group. **Difference in two groups at BL was statistically analyzed by Student t test or Mann-Whitney U test. SDAI: simplified disease activity index, HAQ: health assessment questionnaire, PD: Power Doppler, MMP-3: matrix metalloproteinase 3, mTSS: modified Total Sharp Score. Conclusion In RA patients with the residual synovitis under treatment with standard dose of bDMARDs, enhanced treatment decreased the synovitis and suppressed the joint destruction. References [1]Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford). 2014 Nov;53(11):2110-8. [2]Ogata A, Tanaka Y, Ishii T, Kaneko M, Miwa H, Ohsawa S; SHINOBI study group. A randomized, double-blind, parallel-group, phase III study of shortening the dosing interval of subcutaneous tocilizumab monotherapy in patients with rheumatoid arthritis and an inadequate response to subcutaneous tocilizumab every other week: Results of the 12-week double-blind period. Mod Rheumatol. 2018 Jan;28(1):76-84. [3]Takeuchi T, Miyasaka N, Tatsuki Y, Yano T, Yoshinari T, Abe T, Koike T. Baseline tumour necrosis factor alpha levels predict the necessity for dose escalation of infliximab therapy in patients with rheumatoid arthritis. Ann Rheum Dis. 2011 Jul;70(7):1208-15. Disclosure of Interests None declared